HFMA Annual Conference preview: How Vanderbilt University Medical Center built a successful bundled payment program
Dr. Brittany Cunningham from Vanderbilt University Medical Center discusses her upcoming presentation at HFMA's Annual Conference in Nashville. Also in this episode, strategies for cash flow discrepancies with sponsor organization Inovalon.
Medicaid Drug Misclassification Proposed Rule Summary
On May 26, 2023, CMS published in the Federal Register a proposed rule entitled “Medicaid Program; Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program” (88 FR 34238-34296). The rule proposes to implement policies in the Medicaid Drug Rebate Program (MDRP) related to legislative requirements addressing drug misclassification, as well as…
As anticipated, the start of the Medicaid unwinding process has taken a toll on coverage
Fears among healthcare policymakers that the end of the COVID-19 public health emergency would sow chaos in Medicaid have been realized, leading the Biden administration to intensify its mitigation efforts. The end of Medicaid continuous-enrollment provisions is affecting the program in many states. In 21 states that had begun the “unwinding” process since April 1,…
Medicare coverage and coding updates: New Alzheimer’s drugs to be covered, but not universally
Note: This article was updated July 6. For drugs manufactured to slow the progression of Alzheimer’s disease, Medicare will offer coverage with certain qualifications, according to a recent CMS announcement. The new policy especially is relevant because the FDA’s first full approval of an Alzheimer’s disease drug may be only a month or so away.…
Why it’s so essential for hospitals to embrace a value-based payment strategy
Few would argue today that U.S. hospitals are facing the most challenging operating conditions in a generation, and perhaps longer. From dealing with myriad severe short-term operating strains, such as workforce shortages, to existential threats to their long-term future, including being cast as the enemy in the fight against rising healthcare costs, hospital leaders are…
Ensuring Access to Medicaid Services Proposed Rule Summary
On May 3, 2023, CMS published in the Federal Register a proposed rule entitled “Medicaid Program; Ensuring Access to Medicaid Services” (88 FR 27960-28089). The rule proposes policies that take a comprehensive approach to improving access to care, quality and health outcomes, and better addressing health equity issues in the Medicaid program across fee-for-service, managed care delivery…
Healthcare News of Note: The top 5 reasons U.S. adults say the nation’s healthcare system fails to meet their needs
Nearly three-quarters of adults say the U.S. healthcare system is not meeting their needs in some way, with the length of time to get an appointment the No. 1 reason. The top benefit of using remote patient monitoring during cancer care is to keep the care team up to date on symptoms in between appointments,…
Report quantifies the financial impact of certain health plan business practices on providers
As hospitals seek to regain their financial footing coming out of the pandemic, they may find themselves stymied by commercial payer policies, according to a new report. “It’s true that commercial payers might generate more net revenue than public payers on a per-case basis,” Crowe states in a report it recently published. “But at what…
How healthcare organizations navigate claims processing
View the results of a survey about claims processing and revenue cycle performance conducted with more than 625 healthcare leaders.
News Briefs: The expiration of the COVID-19 PHE brings an end to key provisions
The termination of the COVID-19 public health emergency (PHE) on May 11 meant providers lost many of the accommodations and regulatory flexibilities that were in place since Jan. 31, 2020. For example, Medicare’s 20% add-on payment for treating COVID-19 cases in the inpatient setting no longer is available. With reported cases and hospitalizations steadily trending…